营养支持药师参与个体化营养药物治疗的实践

Practice of Nutrition Support Pharmacists Participating in Individualized Nutritional Treatment

目的:探讨营养支持药师在个体化营养药物治疗中的作用。方法:营养支持药师参与1例食管癌患者的治疗过程。该患者由于病情进展,需改行放疗,营养支持药师根据其病情、外周静脉输注要求和经济状况,建议在原营养支持方案的基础上改行肠外肠内联合营养:肠外营养采用"全合一"营养液[含5%葡萄糖注射液250 m L、50%葡萄糖注射液100 m L、20%中/长链脂肪乳注射液(C6～24)250 m L、8.5%复方氨基酸注射液(18AA-Ⅱ)250 m L、10%氯化钾注射液10 m L、注射用水溶性维生素1支和脂溶性维生素注射液(Ⅱ)10 m L,渗透压为750 m Osm/L]870 m L,外周静脉输注,每日1次;肠内营养为肠内营养粉剂55.8 g加温水250m L冲泡,口服,每日2～3次。根据患者身体状况及进食量,建议将肠内营养粉剂的用药频次增至每日4～5次,并逐渐停用"全合一"肠外营养液。结果:医师采纳营养支持药师的建议,患者营养状况良好,共顺利完成17次放疗,于入院第37天出院。结论:营养支持药师作为临床治疗团队中的一员,从患者的实际需要和诉求出发,发挥自身药学优势,从营养支持途径、输液方式、营养液配比等方面对营养方案进行了优化和调整,在遵循医疗实践客观规律的前提下,充分尊重了患者的个人意愿,为改善其营养状态、保证抗肿瘤治疗的顺利完成奠定了基础。

OBJECTIVE： To investigate the role of nutrition support pharmacists in individualized nutritional treatment. METH- ODS： The nutrition support pharmacists participated in the treatment for a patient with esophageal cancer. The patient received radiotherapy instead according the progression of disease. Nutrition support pharmacists suggested that parenteral and enteral nutrition instead of previous nutrition support plan according to disease condition, the requirements of peripheral venous infusion, economic condition. Parenteral nutrition used peripheral venous infusion of ＂all in one＂ nutrient solution [containing 5% Glucose injection 250 mL, 50% Glucose injection 100 mL, 20% Medium and long chain fat emulsion injection （C6-24） 250 mL, 8.5% Compound amino acid injection （ 18AA- Ⅱ ） 250 mL, 10% Potassium chloride injection 10 mL, Water-soluble vitamin for injection 1 branch, Fat-soluble vitamin injection （ Ⅱ ） 10 mL, osmotic pressure 750 mOsm/L] 870 mL, once a day. Enteral nutrition was Enteral nutritional powder 55.8 g mixed with warm water 250 mL, po, 2-3 times a day. According to physical condition and food intake, it was suggested to increase the frequency of Enteral nutritional powder to 4-5 times a day, gradually discontinued ＂all in one＂ paren- teral nutrition. RESULTS： Physicians adopted the suggestions of nutrition support pharmacists; the patient had a good nutritional status and completed 17 fadiotherapy successfully, and discharged from hospital on 37th day. CONCLUSIONS： Nutrition support pharmacists as a member of clinical treatment team play their own pharmaceutical advantages to optimize and adjust the nutritional program in respects of nutrition support way, infusion mode and nutrient solution ratio from the actual needs and aspirations of pa- tients. Under the premise of following the objective rules of medical practice, the nutrition support pharmacists fully respected the individual wishes of patients to lay a foundation for improving the nutritional status and ensuring the successful completion of an- ti-tumor treatment.